Friday, March 27, 2015

Group Speech Therapy at the Pool

“Aquatic therapy and children…is a medium… (in which) great things… (may) happen in the physical, cognitive and psycho-social realms…while providing a natural environment in which to practice ADL skills, communication skills, problem solving skills and motor skills…”
(From APT Newsletter, October, 1995, “Aquatic Therapy and Children—Welcome to the Water”, by Dori Maxon, PT, specializing in pediatric physical therapy for children with a variety of limitations including gross motor involvement.)

The idea of “Natural Environments” is a concept synonymous with Early Intervention.  As specialists, we provide our services most often in the naturally occurring setting, the family’s home.  Often, an Early Intervention site suggests a structured group setting for a youngster in need of peer modeling and other socialization opportunities.  The challenge for the therapists working at Hasbro Hospital’s Early Intervention Program in Rhode Island was finding a “natural” space where youngsters could be among typical peers and benefit from group instruction lead by a team of therapists. 
One day back in 2003, I was observing a toddler in his Gymboree class when somehow the topic of Early Intervention groups came up with another Speech Therapist from Meeting Street School in Rhode Island.  She had found a rental at the Jewish Community Center (JCC) in Providence and was co-treating a pool group with a physical therapist.  Shortly after, I found myself observing her group with my own “physical therapist partner –in-crime,” Kate Sparrow!  We watched, listened and took notes.  Clearance was easier than I thought; all it took was a couple phone calls to the Risk Management office at Rhode Island Hospital and we were ready to start a pool group for Hasbro Children’s Hospital’s Early Intervention Program.  Some would argue that the pool was not a “natural environment” since the families could not frequent the pool outside of our session and typically developing peers would not be participating, but it was a start and we were determined to help address a multitude of needs while showing families another option to enjoy time with their children. 
Finding people to participate was quick and easy.  Kate and I spread the word to our clients and asked co-workers to share the information on their home visits with children who might benefit from the group.  We suggested that families get medical clearance from their pediatricians since some clients were medically fragile.  We started with 6-10 families and asked caregivers to provide 1:1 assistance with their children.  Some families brought their babysitter/nannies/grandparents along to care for siblings who were watching on the sidelines!  Our attendance was nearly perfect and to this day, I’m not sure who had the most fun at those sessions, the therapists, kids, caregivers, or lifeguard (who often sang our songs with us while sitting in her chair!)
Music was an essential element to our group.   We used songs paired with movements that promoted speech and movement in a fun, rhythmical manner.  Our sequence became predictable since we always started and finished with the same songs.   Before we started our first session, we distributed a “Pool Group Agenda” that explained the sequence of our session in a parent-friendly manner and it discussed the developmental goals that the group would encourage.   The agenda explained that we would open with a welcome song to promote name recognition, greeting, turn taking, gesturing/vocalization.  We then noted that music and singing would be encouraged throughout several activities.  A complete description of Developmental targets for pool group are defined in this link:
Developmental Skills Addressed During Pool Group
Moving along on the agenda, we discussed that bubble play would entice children to use hand and eye coordination to “pop” bubbles with their hands and kick at them with their feet.  Bubbles were also a great motivator for children to request “more” through gestures, sounds, and words.   Following this description were summaries discussing target goals for slide and ball play.   Finally, the agenda noted that closing songs would not only promote following directions, but also closure for play activities. 
Amidst all this structure, we also let families enjoy some “free time” in the water with their children using kick boards and noodles for much splashing opportunities!  The best part about a group in this medium was that it excluded no one and included everyone regardless of age, cognitive or physical ability levels.  Our clients included children with Cerebral Palsy, Down syndrome,   Apraxia, Autism, and Expressive language delays to name just a few.

Flash forward to March 2015:  Our family relocated to Illinois several years ago and I launched both this blog and my private practice:  Naperville Therapediatrics.  Last Spring, after completing my part-time contract in a Catholic school, I started working full time in my home office.  While it's time consuming acting as an office administrator and speech pathologist, I can honestly say that I will never go back to working for someone else!  I've been fortunate enough to have found a private OT/PT practice within a couple miles of my home office and we have been referring clients to each other to improve services for families.  It was this relationship that fueled me once again to investigate starting another pool group.  After making several calls and following leads over the last two months, I'm pleased to announce that this July, my practice will be holding a six week language enrichment group at Rush Copley Healthplex in Aurora, IL!  I will be signing my contract soon and I'm hoping to not only have the OT/PT group: Fingerprints join forces with me, but also an ABA group has shown interest in participating at the pool!  Other than signing the contract and paying a nominal fee per client for the pool rental, all I need to do is add Rush Copley to my insurance liability policy.  I will bill participant's individual insurance policies using the 92508 group procedure code for our 30-40 minute session.  I couldn't be more excited and I'm hoping to offer more groups at the pool once this pilot one is complete in early August.  Below are some of the handouts that I used years ago as well as a link to a service note that we designed collaboratively at Hasbro Early Intervention.  I hope that this post has inspired you to step out of your comfort zones and seek natural opportunities for enhancing communication too!  Please feel free to contact me with any questions that you may have about how to start a speech language pool group at
Handouts for pool group
  • Water-play sections from Talking Time- Language Enrichment Activities for the Very Young from the Speech Bin.
  • Water Fun and Swimming by Caroline Larson, OTR from Pro-ed, Inc., 1990
  • Talking During Bath time by Anthony B. DeFeo, PhD, Diann D. Grimm, MA, CCC-EdS, and Patricia A. Paige, MS, CCC-SLP from Pro-Ed, Inc., 1988
  • Making Range of Motion Exercises Part of Your Child’s Day by Mary O’Connell, PT from Pro-ed, Inc., 1990

“Aquatic Therapy and Children—Welcome to the Water!” excerpt from APT aquatic therapy workshop by Dori Maxon, PT; APT Newsletter, 10/1995
Note: APT= Association of Pediatric Therapists; based in San Francisco Bay Area
For membership: APT, 1193 Clear Lake Court, Milpitas, CA 95035

1 comment:

  1. Group speech therapy at the pool sounds fun! Participants will surely have fun while learning. Additionally, getting family members and loved ones to join the program is even better.